American Stroke Association, Jan. 24-26

The annual International Stroke Conference of the American Heart Association was held from Jan. 24 to 26 in Houston and attracted nearly 4,000 participants from around the world, including cerebrovascular research and practice experts. The conference featured more than 1,500 presentations that emphasized basic, clinical, and translational medicine, and provided insight into the prevention, management, and treatment of stroke.

In one study, Devin L. Brown, M.D., of the University of Michigan in Ann Arbor, and colleagues performed portable sleep apnea tests on approximately 850 ischemic stroke patients about 13 days after stroke onset within the Brain Attack Surveillance in Corpus Christi project.

“We found that our physiological measure of sleep apnea (the respiratory event index) was associated with the combined outcome of post-stroke deaths and recurrent stroke at 30 days after stroke,” Brown said. “This association was present even after accounting for other factors that could have been responsible for the relationship.”

In terms of recurrent stroke alone, the investigators found that the physiological measure of sleep apnea was associated with stroke recurrence both early and late after stroke (divided at the 18-month post-stroke time point) in non-Hispanic whites. However, in Mexican Americans, the investigators found that sleep apnea was associated with stroke recurrence only before 18 months, not after.

“Although it has been known that sleep apnea is very common after stroke and appears to be associated with poor stroke outcomes, no prospective data have been available about the relationship between sleep apnea and recurrent stroke and mortality from population-based studies, large samples, or ethnically diverse populations,” Brown said. “Based on our results, we conclude that sleep apnea may represent an important modifiable risk factor for poor stroke outcomes. Clinical trials are needed to answer definitively whether treatment of sleep apnea reduces post-stroke mortality and recurrent stroke.”

In another study, Sandro Marini, M.D., of Massachusetts General Hospital in Boston, and colleagues aimed to determine whether genetic-based ancestry is a better tool for understanding how race and ethnicity contribute to disease risk. The investigators compared genetic-based ancestry with the traditional self-reported race and ethnicity questionnaire, using the example disease of intracerebral hemorrhage and its vascular risk factors.

“We found that the ancestry definition based on genetics provided more information about a participant’s vascular risk factors, such as hypertension or diabetes, than self-reported race/ethnicity alone. Within each self-reported race/ethnicity group in our study, there was still variation in vascular risk factor that only genetic ancestry could discern. Additionally, our statistical model of intracerebral hemorrhage had an improved prediction of risk when genetic ancestry was added to the standard self-reported race/ethnicity,” Marini said. “Genetic ancestry represents an accurate way to control for both genetic and environmental exposures that vary across races and ethnicities, in association with risk factors for intracerebral hemorrhage. Limiting our definitions of race and ethnicity to standard self-reported information leaves out valuable information that could be used to better predict risk of at least some complex diseases.”

William Powers, M.D., of the University of North Carolina in Chapel Hill, presented recommendation updates to the acute ischemic stroke guidelines for practicing clinicians caring for these patients.

“These guidelines detail prehospital care, urgent and emergency evaluation and treatment with intravenous and intra-arterial therapies, and in-hospital management, including secondary prevention measures that are appropriately instituted within the first two weeks. The guidelines support the overarching concept of stroke systems of care in both the prehospital and hospital settings,” according to Powers and colleagues. “These guidelines are based on the best evidence currently available. In many instances, however, only limited data exist demonstrating the urgent need for continued research on treatment of acute ischemic stroke.”

FRIDAY, Jan. 26, 2018 (HealthDay News) — For stroke survivors, high adherence to the MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet is associated with a slower rate of cognitive decline, according to a study presented at the American Stroke Association’s International Stroke Conference, held from Jan. 24 to 26 in Los Angeles.

THURSDAY, Jan. 25, 2018 (HealthDay News) — For patients with intermediate risk of cardiovascular disease, combining antihypertensive therapy and statin medications is associated with a 44 percent reduction in stroke, according to a study presented at the American Stroke Association’s International Stroke Conference, held from Jan. 24 to 26 in Los Angeles.

THURSDAY, Jan. 25, 2018 (HealthDay News) — For patients with proximal middle-cerebral-artery or internal-carotid-artery occlusion, endovascular therapy six to 16 hours after they were last known to be well is associated with improved outcomes, according to a study published online Jan. 24 in the New England Journal of Medicine. The research was published to coincide with the American Stroke Association’s International Stroke Conference, held from Jan. 24 to 26 in Los Angeles.

THURSDAY, Jan. 25, 2018 (HealthDay News) — Few U.S. stroke survivors display ideal cardiovascular health, according to a study presented at the American Stroke Association’s International Stroke Conference, held from Jan. 24 to 26 in Los Angeles.

WEDNESDAY, Jan. 24, 2018 (HealthDay News) — Many stroke patients referred to rehabilitation services do not receive these services, according to a study presented at the American Stroke Association’s International Stroke Conference, held from Jan. 24 to 26 in Los Angeles.

WEDNESDAY, Jan. 24, 2018 (HealthDay News) — Spontaneous subarachnoid hemorrhage (sSAH) is increasing among pregnant women, according to a study presented at the American Stroke Association’s International Stroke Conference, held from Jan. 24 to 26 in Los Angeles.